Racial Disparities in the Use of MRI and PET Scan Among Medicare Beneficiaries With Prostate Cancer.

Abstract

Background: Despite recent advances in imaging technologies for prostate cancer (PCa) staging, unequal access to new technologies may aggravate racial disparities. We aim to investigate racial disparities in the utilization of Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) scans in a sample of 100% Medicare beneficiaries.

Methods: In this retrospective cross-sectional study, we analyzed 100% Medicare insurance claims from 2018 to 2023. We included male beneficiaries aged 66 and above diagnosed with PCa between January 1, 2019 and December 31, 2023. The primary outcome measure was the receipt of advanced imaging within 1 year after PCa diagnosis. Patient characteristics included race/ethnicity, age, U.S. region, county type, year of diagnosis, comorbidities, dual eligibility for Medicare, and disability status. Chi-squared tests and clustered multivariable regression analyses were conducted to assess differences in the utilization of advanced imaging among patient subgroups.

Results: We identified a total of 749,202 Medicare beneficiaries diagnosed with PCa in the study period. The study cohort was 84.0% White, 8.7% Black, 4.1% other, and 3.2% unknown race/ethnicity. Black men were less likely to receive MRI (OR 0.84,95% CI 0.80-0.89, p < 0.0001) and PET scan (OR 0.87,95% CI 0.84-0.91, p < 0.0001) compared to White men. Absolute utilization of MRI for PCa staging remains low, while PET scan utilization increased from 6% in 2019% to 21% in 2023.

Conclusions: Utilization of advanced imaging in men with newly diagnosed PCa is significantly lower among Black men compared to White men. Improving equal access to new technologies is essential to reducing racial disparities in PCa care.